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Morphine Sul 1mg/ml Inj 10ml

Manufacturer HOSPIRA Active Ingredient Morphine Injection(MOR feen) Pronunciation MOR-feen
WARNING: For all injections:This is an opioid drug. Opioid drugs can put you at risk for drug use disorder. These can lead to overdose and death. You will be watched closely while taking this drug. Severe breathing problems may happen with this drug. The risk is highest when you first start taking this drug or any time your dose is raised. These breathing problems can be deadly. Call your doctor right away if you have slow, shallow, or trouble breathing.Even one dose of this drug may be deadly if it is taken by someone else or by accident, especially in children. If this drug is taken by someone else or by accident, get medical help right away.Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.Do not take more than what your doctor told you to take. Do not take more often or for longer than you were told. Doing any of these things may raise the chance of severe side effects.Severe side effects have happened when opioid drugs were used with benzodiazepines, alcohol, marijuana, other forms of cannabis, or street drugs. This includes severe drowsiness, breathing problems, and death. Benzodiazepines include drugs like alprazolam, diazepam, and lorazepam. If you have questions, talk with the doctor.Many drugs interact with this drug and can raise the chance of side effects like deadly breathing problems. Talk with your doctor and pharmacist to make sure it is safe to use this drug with all of your drugs.Get medical help right away if you feel very sleepy, very dizzy, or if you pass out. Caregivers or others need to get medical help right away if the patient does not respond, does not answer or react like normal, or will not wake up.If you are pregnant or plan to get pregnant, talk with your doctor right away about the benefits and risks of using this drug during pregnancy. Using this drug for a long time during pregnancy may lead to withdrawal in the newborn baby. Withdrawal in the newborn can be life-threatening if not treated.Injection (if given into the spine):You will be watched closely for breathing problems and other severe effects for at least 24 hours after getting this drug. @ COMMON USES: It is used to manage pain when non- opioid pain drugs do not treat your pain well enough or you cannot take them.
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Drug Class
Opioid Analgesic
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Pharmacologic Class
Opioid Agonist
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Pregnancy Category
D
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FDA Approved
Jan 1970
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DEA Schedule
Schedule II

Overview

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What is this medicine?

Morphine is a strong pain medicine that works in your brain and spinal cord to change how your body feels and responds to pain. It is used for moderate to severe pain, especially when other pain medicines haven't worked.
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How to Use This Medicine

Taking Your Medication Correctly
To ensure safe and effective use, take this medication exactly as directed by your doctor. Carefully read all the information provided to you and follow the instructions closely. This medication is administered via injection into a muscle, vein, or the fatty layer under the skin.

Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist for guidance on proper storage procedures.

Missing a Dose
If you miss a dose, contact your doctor immediately to determine the best course of action.
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Lifestyle & Tips

  • Do not drive or operate heavy machinery until you know how this medicine affects you, as it can cause drowsiness and dizziness.
  • Avoid alcohol and other sedating medications (like sleeping pills, anxiety medications) while taking morphine, as this can increase the risk of serious side effects like severe drowsiness and breathing problems.
  • To prevent constipation, drink plenty of fluids, eat fiber-rich foods, and use a stool softener or laxative as recommended by your doctor.
  • Do not share this medication with anyone else, as it can be dangerous and is illegal.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: IV: 2-10 mg every 3-4 hours as needed; IM/SC: 5-20 mg every 3-4 hours as needed
Dose Range: 2 - 20 mg

Condition-Specific Dosing:

acute_pain_iv: Initial 2-4 mg, may titrate in 1-2 mg increments every 5-15 minutes until pain relief or unacceptable side effects. Maintenance 2-10 mg every 3-4 hours.
acute_pain_im_sc: Initial 5-10 mg, may be repeated every 3-4 hours as needed.
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Pediatric Dosing

Neonatal: Not established for routine use; extreme caution and reduced doses if used (e.g., 0.01-0.03 mg/kg/dose IV/IM/SC).
Infant: IV/IM/SC: 0.05-0.2 mg/kg/dose every 2-4 hours as needed; maximum 15 mg/dose.
Child: IV/IM/SC: 0.05-0.2 mg/kg/dose every 2-4 hours as needed; maximum 15 mg/dose.
Adolescent: IV/IM/SC: 0.05-0.2 mg/kg/dose every 2-4 hours as needed; maximum 15 mg/dose (or adult dosing if appropriate weight).
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Dose Adjustments

Renal Impairment:

Mild: Consider dose reduction or extended dosing interval.
Moderate: Reduce dose by 25-50% or extend dosing interval due to accumulation of active metabolites (M6G).
Severe: Reduce dose by 50-75% or extend dosing interval significantly; avoid if possible.
Dialysis: Morphine and its metabolites are dialyzable to some extent; supplemental dose may be needed post-dialysis, but caution is advised due to variable clearance.

Hepatic Impairment:

Mild: No specific adjustment, but monitor closely.
Moderate: Reduce dose by 25-50% and/or extend dosing interval.
Severe: Reduce dose by 50-75% and/or extend dosing interval; avoid if possible.

Pharmacology

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Mechanism of Action

Morphine is a full opioid agonist that binds to and activates mu-opioid receptors in the central nervous system (CNS), peripheral tissues, and gastrointestinal tract. Activation of these receptors leads to inhibition of pain signal transmission, resulting in analgesia. It also produces other effects such as sedation, euphoria, respiratory depression, miosis, and decreased gastrointestinal motility.
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Pharmacokinetics

Absorption:

Bioavailability: 100% (IV/IM/SC); 20-40% (oral, due to first-pass metabolism)
Tmax: IV: 10-20 minutes; IM: 30-60 minutes; SC: 60-90 minutes
FoodEffect: Not applicable for injection; oral bioavailability can be affected by food.

Distribution:

Vd: 1-4 L/kg
ProteinBinding: 20-35%
CnssPenetration: Yes, but limited by P-glycoprotein efflux.

Elimination:

HalfLife: 2-4 hours (parent drug); M6G half-life is longer, especially in renal impairment.
Clearance: Approximately 15-30 mL/min/kg
ExcretionRoute: Renal (primarily as glucuronide metabolites, ~90%), small amount in feces (biliary excretion).
Unchanged: <10%
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Pharmacodynamics

OnsetOfAction: IV: 5-10 minutes; IM: 10-30 minutes; SC: 15-60 minutes
PeakEffect: IV: 20 minutes; IM: 30-60 minutes; SC: 60-90 minutes
DurationOfAction: 3-5 hours (for single dose)

Safety & Warnings

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BLACK BOX WARNING

RISK OF ADDICTION, ABUSE, AND MISUSE; RESPIRATORY DEPRESSION; NEONATAL OPIOID WITHDRAWAL SYNDROME; ACCIDENTAL INGESTION; CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS.
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Side Effects

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:

Signs of an allergic reaction, including:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
 Signs of low blood sugar, such as:
+ Dizziness or lightheadedness
+ Headache or feeling sleepy or weak
+ Shaking or confusion
+ Fast heartbeat or hunger
+ Sweating
Severe dizziness or fainting
 Chest pain or pressure, or a rapid heartbeat
Confusion or disorientation
 Breathing difficulties, including:
+ Slow or shallow breathing
+ Noisy breathing
+ Sleep apnea (breathing problems during sleep)
Seizures
 Severe constipation or stomach pain, which may indicate a bowel problem
Depression or mood changes
 Swelling in the arms or legs
Fever, chills, or sore throat
 Painful urination
Abnormal sensations, such as burning, numbness, or tingling
 Serotonin syndrome, a potentially life-threatening condition, which may occur when taking this medication with certain other drugs. Symptoms include:
+ Agitation or changes in balance
+ Confusion or hallucinations
+ Fever or rapid heartbeat
+ Flushing or muscle twitching or stiffness
+ Seizures or shivering
+ Excessive sweating or severe diarrhea, nausea, or vomiting
+ Severe headache
Adrenal gland problems, which may occur with long-term opioid use. Symptoms include:
+ Extreme fatigue or weakness
+ Fainting or severe dizziness
+ Severe nausea or vomiting
+ Decreased appetite
 Hormonal changes, which may occur with long-term opioid use. Symptoms include:
+ Decreased sex drive
+ Fertility problems
+ Irregular menstrual periods or ejaculation problems

Additional Side Effects

Most people taking this medication will not experience severe side effects. However, some may encounter mild or moderate side effects. If you experience any of the following symptoms, contact your doctor if they persist or bother you:

Dizziness, drowsiness, fatigue, or weakness
 Dry mouth
Constipation, diarrhea, stomach pain, nausea, vomiting, or decreased appetite
 Headache
Anxiety
 Excessive sweating

Reporting Side Effects

If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Important Notes for Injection Administration (Spinal)

If you receive this medication via spinal injection, be aware of the following potential side effects:

Loss of motor function
 Muscle spasms
Difficulty controlling body movements
 Urination problems
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Seek Immediate Medical Attention If You Experience:

  • Slow or shallow breathing (less than 10 breaths per minute for adults)
  • Extreme drowsiness or difficulty waking up
  • Feeling dizzy or lightheaded when standing up
  • Blue lips or fingernails
  • Severe constipation or inability to have a bowel movement
  • Confusion or hallucinations
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Before Using This Medicine

Before Taking This Medication: Important Information to Share with Your Doctor

To ensure your safety while taking this medication, it is crucial that you inform your doctor about the following:

Any allergies you have, including allergies to this drug, its components, or other substances, such as foods or medications. Describe the allergic reactions you have experienced.
 Certain health conditions, including:
+ Respiratory issues like asthma, breathing difficulties, or sleep apnea
+ Elevated carbon dioxide levels in the blood
+ Stomach or bowel obstruction or narrowing
Recent use (within the last 14 days) of specific medications for depression or Parkinson's disease, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure
 Current use of the following medications: buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine

If You Are Receiving This Medication via Spinal Injection:

Inform your doctor if you have an infection at the injection site
 Disclose any bleeding disorders you may have
* Advise your doctor if you are taking anticoagulant medications (blood thinners)

This list is not exhaustive, and it is essential to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health issues you are experiencing. Your healthcare team will assess the safety of taking this medication in conjunction with your other treatments and health conditions. Never initiate, terminate, or adjust the dosage of any medication without consulting your doctor.
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Precautions & Cautions

Important Information About Your Medication

It is crucial that you inform all of your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Caution with Daily Activities
Until you understand how this medication affects you, avoid driving and engaging in other activities that require your full attention. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.

Interactions with Other Medications
Do not take this medication concurrently with other strong pain medications or use a pain patch without first consulting your doctor.

Monitoring Your Pain
If your pain worsens, you experience increased sensitivity to pain, or you develop new pain after taking this medication, contact your doctor immediately. Do not exceed the prescribed dosage.

Tolerance and Dependence
Long-term or high-dose use of this medication may lead to tolerance, where the medication becomes less effective, and higher doses are required to achieve the same effect. If you experience a decrease in the medication's effectiveness, consult your doctor. Do not take more than the prescribed amount.

Additionally, prolonged or regular use of opioid medications like this one can result in dependence. If you need to reduce the dose or stop taking this medication, consult your doctor first, as abruptly stopping or lowering the dose can increase the risk of withdrawal or other severe issues. Follow your doctor's instructions carefully and report any increased pain, mood changes, suicidal thoughts, or other adverse effects.

Allergies and Interactions
If you are allergic to sulfites, discuss this with your doctor, as some products contain sulfites. Avoid consuming alcohol or using products that contain alcohol, as this can lead to unsafe and potentially fatal consequences.

Seizure Risk
This medication may increase the risk of seizures in certain individuals, including those with a history of seizures. Consult your doctor to determine if you are at a higher risk of seizures while taking this medication.

Special Precautions
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects. Inform your doctor if you are breastfeeding, as this medication can pass into breast milk and potentially harm your baby. If your baby appears excessively sleepy, limp, or has breathing difficulties, seek medical attention immediately.
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Overdose Information

Overdose Symptoms:

  • Pinpoint pupils
  • Extreme drowsiness or unresponsiveness
  • Slow, shallow, or stopped breathing
  • Cold, clammy skin
  • Limp muscles
  • Blue discoloration of lips or skin (cyanosis)

What to Do:

If you suspect an overdose, call 911 immediately. If available, administer naloxone (Narcan) if the person is unresponsive or has difficulty breathing, and stay with them until emergency medical help arrives. Provide rescue breathing if necessary.

Drug Interactions

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Contraindicated Interactions

  • Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of MAOI therapy (risk of serotonin syndrome, severe respiratory depression, coma, death).
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Major Interactions

  • Benzodiazepines and other CNS depressants (e.g., other opioids, sedatives/hypnotics, general anesthetics, tranquilizers, skeletal muscle relaxants, alcohol): Increased risk of profound sedation, respiratory depression, coma, and death.
  • Mixed Agonist/Antagonist Opioid Analgesics (e.g., butorphanol, nalbuphine, pentazocine): May reduce the analgesic effect of morphine and/or precipitate withdrawal symptoms.
  • Serotonergic Drugs (e.g., SSRIs, SNRIs, TCAs, triptans): Risk of serotonin syndrome (though less direct for morphine, caution advised).
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Moderate Interactions

  • Anticholinergics (e.g., atropine, scopolamine): Increased risk of urinary retention and/or severe constipation.
  • Diuretics: Opioids may reduce the efficacy of diuretics by inducing the release of antidiuretic hormone.
  • Muscle Relaxants: Enhanced neuromuscular blockade.
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Minor Interactions

  • Not specifically identified as minor, but general caution with any drug affecting CNS or GI motility.

Monitoring

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Baseline Monitoring

Pain Assessment (e.g., NRS, VAS)

Rationale: To establish baseline pain level and guide initial dosing.

Timing: Prior to first dose

Vital Signs (Respiratory Rate, Heart Rate, Blood Pressure)

Rationale: To assess baseline cardiorespiratory status and identify potential contraindications or risks.

Timing: Prior to first dose

Level of Consciousness/Sedation Score

Rationale: To assess baseline neurological status and risk of over-sedation.

Timing: Prior to first dose

Bowel Function Assessment

Rationale: To assess baseline bowel habits and plan for constipation prophylaxis.

Timing: Prior to first dose

Renal and Hepatic Function Tests (e.g., CrCl, LFTs)

Rationale: To identify impairment that may necessitate dose adjustment.

Timing: Prior to initiation, especially in patients with known or suspected impairment

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Routine Monitoring

Pain Assessment

Frequency: Every 1-4 hours initially, then as needed based on patient response and stability.

Target: Patient-specific pain goal (e.g., <4/10 on NRS)

Action Threshold: Pain not adequately controlled, requiring dose adjustment or alternative therapy.

Respiratory Rate and Depth

Frequency: Every 15-30 minutes for 1-2 hours after IV dose, then every 1-4 hours or as clinically indicated.

Target: >10-12 breaths/minute (adults), age-appropriate for pediatrics, regular rhythm.

Action Threshold: <10 breaths/minute (adults), shallow breathing, signs of respiratory distress; administer naloxone and/or provide respiratory support.

Sedation Level (e.g., Pasero Opioid-Induced Sedation Scale)

Frequency: Concurrently with respiratory rate monitoring.

Target: Alert or mildly drowsy, easily aroused.

Action Threshold: Difficult to arouse, somnolent, or unarousable; hold dose, consider naloxone.

Oxygen Saturation (SpO2)

Frequency: Continuous or intermittent, especially with higher doses or risk factors for respiratory depression.

Target: >92-94%

Action Threshold: <90% (or patient-specific baseline); administer oxygen, consider naloxone.

Bowel Movements

Frequency: Daily

Target: Regular bowel movements (e.g., every 1-2 days)

Action Threshold: No bowel movement for 2-3 days; initiate or escalate laxative regimen.

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Symptom Monitoring

  • Respiratory depression (slow, shallow breathing)
  • Excessive sedation/drowsiness
  • Nausea and vomiting
  • Constipation
  • Pruritus (itching)
  • Urinary retention
  • Dizziness/lightheadedness
  • Confusion

Special Patient Groups

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Pregnancy

Morphine can cause neonatal opioid withdrawal syndrome (NOWS) if used for a prolonged period during pregnancy. NOWS can be life-threatening if not recognized and treated. Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus.

Trimester-Specific Risks:

First Trimester: Limited data, but potential for congenital malformations cannot be ruled out, though not consistently demonstrated.
Second Trimester: Risk of fetal growth restriction and other adverse outcomes with prolonged use.
Third Trimester: High risk of neonatal opioid withdrawal syndrome (NOWS) if used chronically. Risk of respiratory depression in the neonate if used close to delivery.
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Lactation

Morphine is excreted into breast milk. While levels are generally low, infants should be monitored for signs of sedation, poor feeding, and respiratory depression. A single dose is generally considered compatible with breastfeeding, but chronic use is not recommended.

Infant Risk: Moderate to high risk (L4) with chronic use due to potential for infant sedation, respiratory depression, and withdrawal symptoms upon discontinuation of breastfeeding. Monitor infant closely for drowsiness, difficulty breathing, or poor feeding.
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Pediatric Use

Pediatric patients, especially neonates and infants, are more sensitive to the respiratory depressant effects of opioids. Dosing must be carefully calculated based on weight and titrated slowly. Close monitoring for respiratory depression and sedation is crucial.

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Geriatric Use

Elderly patients may be more sensitive to the analgesic and adverse effects of morphine, including respiratory depression, sedation, and constipation, due to decreased renal and hepatic function, reduced lean body mass, and polypharmacy. Start with lower doses and titrate slowly, monitoring closely for adverse effects.

Clinical Information

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Clinical Pearls

  • Morphine is a potent opioid with a high potential for abuse, addiction, and diversion. Prescribe and dispense with extreme caution.
  • Always have naloxone readily available when administering morphine, especially in opioid-naive patients or when titrating doses.
  • Proactive management of opioid-induced constipation is essential, as it is a common and often distressing side effect that patients do not develop tolerance to.
  • Titrate dose slowly to effect, especially in patients with risk factors for respiratory depression (e.g., elderly, pulmonary disease, concomitant CNS depressants).
  • The 1 mg/mL concentration is often used for continuous infusions or for patients requiring very precise, low-dose titration.
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Alternative Therapies

  • Other strong opioid analgesics (e.g., hydromorphone, fentanyl, oxycodone)
  • Moderate opioid analgesics (e.g., codeine, tramadol) for less severe pain
  • Non-opioid analgesics (e.g., NSAIDs, acetaminophen) for mild to moderate pain or as adjuncts to opioids
  • Regional anesthesia or nerve blocks
  • Non-pharmacological pain management techniques (e.g., physical therapy, acupuncture, cognitive behavioral therapy)
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Cost & Coverage

Average Cost: Varies widely based on concentration, volume, and supplier. per 10ml vial
Generic Available: Yes
Insurance Coverage: Tier 1-3 (often covered as a generic)
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General Drug Facts

If your symptoms or health problems do not improve or worsen, it is essential to contact your doctor promptly. To ensure safe use, do not share your medication with others, and never take someone else's medication. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly; do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist or healthcare provider. You can also inquire about drug take-back programs in your area for safe disposal.

This medication is accompanied by a Medication Guide, which provides crucial information about its safe use. Read this guide carefully and review it again each time you receive a refill. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or other healthcare provider.

In the event of an overdose, a medication called naloxone can be used as an emergency treatment. Discuss obtaining and using naloxone with your doctor or pharmacist. If you suspect an overdose has occurred, seek immediate medical attention, even if naloxone has been administered. Be prepared to provide information about the overdose, including the substance taken, the amount, and the time it occurred, to ensure prompt and effective treatment.